Post-cesarean Section Peritonitis at a Referral Hospital in Rwanda: Factors Associated with Maternal Morbidity and Mortality
| dc.contributor.advisor | Thielman, Nathan | |
| dc.contributor.author | Halfon, Johanna | |
| dc.date.accessioned | 2016-06-06T16:50:51Z | |
| dc.date.available | 2017-05-10T04:30:05Z | |
| dc.date.issued | 2016 | |
| dc.department | Global Health | |
| dc.description.abstract | Background: Post-cesarean section peritonitis is the leading cause of maternal morbidity and mortality at the main referral hospital in Rwanda. Published data on the management of post-cesarean section peritonitis is limited. This study examined predictors of maternal morbidity and mortality for post-cesarean peritonitis. Methods: We performed a prospective observational cohort study at the University Teaching Hospital Kigali (CHUK) from January 1 until December 31 2015, followed by a retrospective chart review of all subjects with post-cesarean section peritonitis admitted to CHUK from January 1 until December 31, 2014. All patients admitted with the diagnosis of post-cesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. Patients were followed to either discharge or death. Study variables included baseline demographic/clinical characteristics, admission physical exam, intraoperative findings, and management. Data were analyzed using STATA version 14. Results: Of the 167 patients enrolled, 81 survived without requiring hysterectomy (49%), 49 survived requiring hysterectomy (29%), and 36 died (22%). In the multivariate analysis, severe sepsis was the most significant predictor of mortality (RR=4.0 [2.2-7.7]) and uterine necrosis was the most significant predictor of hysterectomy (RR=6.3 [1.6-25.2]). There were high rates of antimicrobial resistance (AMR) among the bacterial isolates cultured from intra-abdominal pus, with 52% of bacteria resistant to third-generation cephalosporins. Conclusions: Post-cesarean section peritonitis carries a high mortality rate in Rwanda. It is also associated with a high rate of hysterectomy. Understanding the disease process and identifying factors associated with outcomes can help guide management during admission. | |
| dc.identifier.uri | ||
| dc.subject | Medicine | |
| dc.subject | Antimicrobial resistance | |
| dc.subject | Cesarean Section | |
| dc.subject | Peritonitis | |
| dc.subject | Rwanda | |
| dc.subject | Sepsis | |
| dc.subject | Surgical Site Infection | |
| dc.title | Post-cesarean Section Peritonitis at a Referral Hospital in Rwanda: Factors Associated with Maternal Morbidity and Mortality | |
| dc.type | Master's thesis | |
| duke.embargo.months | 11 |
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